Provider Demographics
NPI:1316151095
Name:ALZHEIMER'S DISEASE RESOURCE AGENCY OF ALASKA, INC.
Entity type:Organization
Organization Name:ALZHEIMER'S DISEASE RESOURCE AGENCY OF ALASKA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:IVORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-864-3415
Mailing Address - Street 1:1750 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3443
Mailing Address - Country:US
Mailing Address - Phone:907-561-3313
Mailing Address - Fax:907-561-3315
Practice Address - Street 1:1750 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3443
Practice Address - Country:US
Practice Address - Phone:907-561-3313
Practice Address - Fax:907-561-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM8386Medicaid
AKCM6608Medicaid
AKCM7271Medicaid
AKCM3745Medicaid
AKCM5282Medicaid
AKCM5452Medicaid
AKCMG736Medicaid
AKCM5237Medicaid
AKPCG736Medicaid
AKCM3752Medicaid
AKHC7736Medicaid